7/25/2019 Skin Pathologies
1/130
Skin
Jeffrey Sosnowski M.D., Ph.D.
7/25/2019 Skin Pathologies
2/130
Learning Objectives
Understanding of brn ty!es
"now#edge of skin #esion ter$ino#ogy
Discss #esions of e!ithe#i$, $e#anocyte
and der$is within conte%t of #esion
ter$ino#ogy and !atho#ogy
Understanding of reactive and hy!ertro!hic
skin #esions
"now#edge of b#istering and infectios #esions
7/25/2019 Skin Pathologies
3/130
Skin &isto#ogy
7/25/2019 Skin Pathologies
4/130
7/25/2019 Skin Pathologies
5/130
7/25/2019 Skin Pathologies
6/130
7/25/2019 Skin Pathologies
7/130
7/25/2019 Skin Pathologies
8/130
7/25/2019 Skin Pathologies
9/130
7/25/2019 Skin Pathologies
10/130
7/25/2019 Skin Pathologies
11/130
'taneos (rns
)st* degree, congestion, !ain, vasodi#ation,
ede$a bt no necrosis
+nd * degree, necrosis of e!ider$is bt s!ares
der$is
(#isters se!arating e!ider$is fro$ der$is
Partia# thickness brn
-rd* degree, carbonied e!ider$is andder$is with #ost of tisse strctre
/## thickness brn
7/25/2019 Skin Pathologies
12/130
&ea#ing of 'taneos (rns
)st degree brns have #itt#e ce###ar da$age and
re0ires basa# ce##s to re!#ace da$ages e!ithe#ia#
ce##s, withot scar for$ation
+nd
degree brns a#so hea# withot a scar becasebasa# ce##s of the e!ider$is are s!ared and
regenerate the e!ider$is
-rd degree brns with s!ared skin a!!endages can
resrface the da$aged skin. Der$a# tisse re!#acesda$ages skin with dense scar
Skin grafts can redce the density of scar
/#id #oss and infection are $ajor !rob#$es
7/25/2019 Skin Pathologies
13/130
Lesion 1er$ino#ogy
7/25/2019 Skin Pathologies
14/130
/#at Lesions
Mac#e
Less than 2 $$,
different co#or than
srronding skin Patch
3reater than 2 $$
7/25/2019 Skin Pathologies
15/130
4aised Lesions
Pa!#e
#ess than 2 $$,
discrete so#id e#evated
#esion P#a0e
3reater than 2$$
7/25/2019 Skin Pathologies
16/130
/#id*/i##ed Lesions
5esic#e
Less than 2 $$, f#id
$ay be c#ear, seros,
he$orrhagic or!r#ent
(##a
3reater than 2 $$
Pst#e Usa##y #ess than 2
$$, fi##ed with !s
7/25/2019 Skin Pathologies
17/130
Sca#e and 'rst
Sca#e 6%cess strat$ corne$,
sa##y white or gray co#or
'rst
7 hardened #ayer ofser$, b#ood or !r#ent
e%date on the srface of
skin
6schar
7dherent thick, dry b#ack
crst
7/25/2019 Skin Pathologies
18/130
Pr!ra8skin he$orrhage9
Petechiae )*+ $$, nonb#anchab#e
$ac#es res#ting fro$
tiny he$orrhages
6cchy$osis 'o##ection of b#ood into
skin or $cos
$e$brane for$ing
$ac#es and !atches Pa#!ab#e !r!ra
P#a0es of ecchy$oses
7/25/2019 Skin Pathologies
19/130
Skin Loss
U#cer
Loss of e!ider$is and
at #east the !!er
der$is 6rosion
Loss of e!ider$a# or
$cosa# e!ithe#i$
7/25/2019 Skin Pathologies
20/130
6P:1&6L:7L 1UMO4S O/6P:1&6L:7L 1UMO4S O/
S":;S":;
7/25/2019 Skin Pathologies
21/130
Seborrheic "eratosisSeborrheic "eratosis
7rise s!ontaneos#y in7rise s!ontaneos#y in
ad#tsad#ts
4ond, f#at,4ond, f#at,
7/25/2019 Skin Pathologies
22/130
/ibroe!ithe#ia# Po#y!/ibroe!ithe#ia# Po#y!
7"7 skin tag, acrochordon,7"7 skin tag, acrochordon,
s0a$os !a!i##o$as0a$os !a!i##o$a
(ag*#ike, f#esh*co#ored !rotrsions(ag*#ike, f#esh*co#ored !rotrsions
/ibrovasc#ar core covered by/ibrovasc#ar core covered by
benign s0a$os e!ithe#i$benign s0a$os e!ithe#i$
7%i##a, neck, trnk, face,7%i##a, neck, trnk, face,
intertriginos areasintertriginos areas 7>? diabetes and intestina#7>? diabetes and intestina#
!o#y!osis!o#y!osis
7/25/2019 Skin Pathologies
23/130
7canthosis ;igricans7canthosis ;igricans
1hickened hy!er!ig$ented skin in f#e%ra#1hickened hy!er!ig$ented skin in f#e%ra#
areasareas 7canthosis of e!ider$is, increased $e#anin !ig$ent7canthosis of e!ider$is, increased $e#anin !ig$ent
(enign ty!e @AB, deve#o!s grada##y in(enign ty!e @AB, deve#o!s grada##y inchi#dhood or !bertychi#dhood or !berty
7ssociated with7ssociated with diabetes, obesitydiabetes, obesity, endocrine, endocrine
t$ors, !o#ycystic ovary syndro$est$ors, !o#ycystic ovary syndro$es Ma#ignant ty!e ad#ts, sdden onset,Ma#ignant ty!e ad#ts, sdden onset,
associated with 3: carcino$aassociated with 3: carcino$a
7/25/2019 Skin Pathologies
24/130
7canthosis ;igricans7canthosis ;igricans
7/25/2019 Skin Pathologies
25/130
7ctinic "eratosis7ctinic "eratosis
Dys!#asia of the s0a$os e!ithe#i$Dys!#asia of the s0a$os e!ithe#i$
secondary to sn e%!osresecondary to sn e%!osre
:oniing radiation:oniing radiation, hydrocarbons, arsenica#s, hydrocarbons, arsenica#s Precrsor of s0a$os ce## carcino$aPrecrsor of s0a$os ce## carcino$a
1an, red or skin co#oredC rogh sand!a!er*1an, red or skin co#oredC rogh sand!a!er*
#ike consistencyC ctaneos horn, )c$#ike consistencyC ctaneos horn, )c$ "eratinocytic aty!ia, hy!erkeratosis,"eratinocytic aty!ia, hy!erkeratosis,
!arakeratosis, and der$a# e#astosis!arakeratosis, and der$a# e#astosis
7/25/2019 Skin Pathologies
26/130
ActinicKeratosis
7/25/2019 Skin Pathologies
27/130
S0a$os 'e## 'arcino$aS0a$os 'e## 'arcino$a
Second $ost co$$on t$or arising onSecond $ost co$$on t$or arising on
sn*e%!osed sites in o#der !eo!#esn*e%!osed sites in o#der !eo!#e
U5 #ightU5 #ight, o#d scars, chronic #cers, fair skin, o#d scars, chronic #cers, fair skin
:$$nos!!ression, %eroder$a:$$nos!!ression, %eroder$a
!ig$entos$!ig$entos$
Ma#es E fe$a#esMa#es E fe$a#es Potentia# for $etastases 82B9Potentia# for $etastases 82B9
7/25/2019 Skin Pathologies
28/130
Squamous CellCarcinoma
S ' ## ' iS ' ## ' i
7/25/2019 Skin Pathologies
29/130
S0a$os 'e## 'arcino$aS0a$os 'e## 'arcino$ainvasive nests of ce##s showing keratiniation g#assy !inkinvasive nests of ce##s showing keratiniation g#assy !ink
cyto!#as$ 8s$a## arrow9, s0a$os !ear#s of e%trace###arcyto!#as$ 8s$a## arrow9, s0a$os !ear#s of e%trace###ar
keratin 8#arge arrow9keratin 8#arge arrow9
7/25/2019 Skin Pathologies
30/130
(asa# ce## carcino$a(asa# ce## carcino$a
Most co$$on invasive cancerMost co$$on invasive cancer,, EFAA,AAA !er year.EFAA,AAA !er year.
Most co$$on t$or on sn*e%!osed skinMost co$$on t$or on sn*e%!osed skin U5 #ight, fair skin, i$$nos!!ression, GPU5 #ight, fair skin, i$$nos!!ression, GP
Pear#y !a!#es, !ig$entation, #cerationPear#y !a!#es, !ig$entation, #ceration
Loca##y invasive Loca##y invasive
7/25/2019 Skin Pathologies
31/130
Basal CellCarcinoma
7/25/2019 Skin Pathologies
32/130
(asa# ce## carcino$a(asa# ce## carcino$a 'e##s rese$b#e nor$a# basa# e!ithe#ia# ce##s'e##s rese$b#e nor$a# basa# e!ithe#ia# ce##s
;od#es, is#ands or cords e%tend downward fro$;od#es, is#ands or cords e%tend downward fro$
e!ider$is or otward fro$ fo##ic#ar e!ithe#i$e!ider$is or otward fro$ fo##ic#ar e!ithe#i$
Peri!hera# !a#isading, c#efts, $cinos or fibrosPeri!hera# !a#isading, c#efts, $cinos or fibros
$atri%$atri%
7/25/2019 Skin Pathologies
33/130
Skin 'arcino$a PathogenesisSkin 'arcino$a Pathogenesis
6niviron$enta# carcinogens *6niviron$enta# carcinogens *
U5 #ightU5 #ight
D;7 da$age 8P1'&, !2-9D;7 da$age 8P1'&, !2-9 direct i$$nos!!ressive effects 8Langerhans ce##s9direct i$$nos!!ressive effects 8Langerhans ce##s9
5ira# transfor$ation5ira# transfor$ation
&P5 se0ences detected in !recrsors&P5 se0ences detected in !recrsors
'he$ica# Mtagens'he$ica# Mtagens
7/25/2019 Skin Pathologies
34/130
7dne%a# 1$ors
7/25/2019 Skin Pathologies
35/130
7dne%a# 1$ors7dne%a# 1$ors
1$ors arising fro$ skin a!!endages1$ors arising fro$ skin a!!endages &air fo##ic#e origin&air fo##ic#e origin trichoe!ithe#io$a, trichi#e$$o$a, trichoe!ithe#io$a, trichi#e$$o$a,
trichofo##ic#o$atrichofo##ic#o$a 6ccrine g#and origin6ccrine g#and origin eccrine !oro$a, chondroid eccrine !oro$a, chondroid
syringo$asyringo$a 7!ocrine g#and origin7!ocrine g#and origin * cy#indro$a* cy#indro$a Sebaceos g#and originSebaceos g#and origin sebaceos adeno$a, sebaceos adeno$a,
carcino$acarcino$a
Usa##y benign, bt $a#ignant for$s e%istUsa##y benign, bt $a#ignant for$s e%ist '#inica##y $ay be confsed with basa# ce##'#inica##y $ay be confsed with basa# ce##
carcino$acarcino$a /#esh co#ored !a!#e or nod#e/#esh co#ored !a!#e or nod#e
7/25/2019 Skin Pathologies
36/130
'y#indro$a'y#indro$a
'o$$on on forehead'o$$on on forehead
and sca#!and sca#!
Often $#ti!#eOften $#ti!#e
:s#ands of basa#oid:s#ands of basa#oidce##s 8!#e !ieces9ce##s 8!#e !ieces9
/ibros $atri%/ibros $atri%
7/25/2019 Skin Pathologies
37/130
Me#anocyte Lesions
7/25/2019 Skin Pathologies
38/130
D:SO4D64S O/ P:3M6;171:O;
VitiligoH $e#anocyte #oss
AlbinismH tyrosinase eny$e defect Freckle8e!he#is9H increased $e#anin
!rodction
MelasmaH increased $e#anin 6!ider$a# ty!e
Der$a# ty!e
7/25/2019 Skin Pathologies
39/130
5:1:L:3O
Loss of $e#anocytes withine!ider$is, res#ting in areasof hy!o!ig$entation
7## ages and races
7sy$!to$atic, f#at
May occr at sites ofre!eated tra$a
I7toi$$ne $echanis$
;O1 a#binis$ 8tyrosinasedeficiency9
7/25/2019 Skin Pathologies
40/130
L6;1:3O
Ova# tan brown
$ac#es, that do not
darken when e%!osed
to sn 8dd% freck#e9 )A$$
:nvo#ve $cos
$e$branes and skin
Linear $e#anocytic
hy!er!#asia,
non*nested, basa#,
8#entiginos9
7/25/2019 Skin Pathologies
41/130
;evi
7/25/2019 Skin Pathologies
42/130
Jnctiona# ;evinests of $e#anocytes at D6 jct
7/25/2019 Skin Pathologies
43/130
(enign ;evi
Jnctiona#, co$!ond,
der$a#
7/25/2019 Skin Pathologies
44/130
M7L:3;7;1 M6L7;OM7
;eo!#as$ derived fro$ $e#anocytes 8or
!ossib#y fro$ nevs ce##s9
Most ra!id#y increasing cancer
:ncidence has dob#ed over #ast -A years
th$ost co$$on cancer 8)stin yong
fe$a#es9
7/25/2019 Skin Pathologies
45/130
Me#ano$a 4isk /actors
/air skin
M#ti!#e benign nevi 8E2A9
Dys!#astic nevi Persona# or fa$i#y history of $e#ano$a
U5 radiation, severe b#istering snbrns
and chronic tanning :$$nodeficiency
7/25/2019 Skin Pathologies
46/130
4isk factors for Me#ano$a
/air skin, $#ti!#e nevi, severesnbrns
7/25/2019 Skin Pathologies
47/130
7/25/2019 Skin Pathologies
48/130
Malignant Melanoma
:rreg#ar sha!e and co#or,#arge, intense#y b#ack, nod#ar
and f#at
M #
7/25/2019 Skin Pathologies
49/130
Me#ano$ansa# sites
7/25/2019 Skin Pathologies
50/130
?arning signs of $e#ano$a
7sy$$etry
(order irreg#arity
'o#or variation
Dia$eter E)A $$
6#evation or for$ation of anod#e
Any change in a nevus
7/25/2019 Skin Pathologies
51/130
3rowth !atterns of $e#ano$a
4adia# growth !hase 8non*t$origenic9 &orionta# growth within e!ider$is and
s!erficia# der$isH no ca!acity to $etastasie
Lentigo $a#igna $e#ano$a sn da$aged facia#skin
S!erficia# s!reading $e#ano$a
7cra# #entiginos $e#ano$a
5ertica# growth !hase 8t$origenic9H 3rowth into dee!er der$isH ca!acity to
$etastasie
;od#e for$ation, e%!ansi#e $ass
Di f t i i
7/25/2019 Skin Pathologies
52/130
Diagra$ of t$or !rogression in
$e#ano$a
7/25/2019 Skin Pathologies
53/130
(etter Prognosis in Me#ano$a ifK
De!th ). $$
Low $itotic>!ro#iferative rate
Lack of #ceration
(risk #y$!hocytic inf#a$$ation
7bsence of regression
/e$a#e gender
Location on e%tre$ity
Lack of $etastasis
Mo#ec#ar 3enetics of Skin 'arcino$aMo#ec#ar 3enetics of Skin 'arcino$a
7/25/2019 Skin Pathologies
54/130
Mo#ec#ar 3enetics of Skin 'arcino$aMo#ec#ar 3enetics of Skin 'arcino$a83or#in Syndro$e983or#in Syndro$e9
;evoid basa# ce## carcino$a;evoid basa# ce## carcino$asyndro$esyndro$e
M#ti!#e ('' at yong age M#ti!#e ('' at yong age
n$eros syste$icn$eros syste$ic
abnor$a#itiesabnor$a#ities
7toso$a# do$inant, chN0++7toso$a# do$inant, chN0++
Defect of P1'& gene withDefect of P1'& gene with
$tations characteristic for$tations characteristic forU5 da$ageU5 da$age
Si$i#ar P1'& gene $tationsSi$i#ar P1'& gene $tations
in s!oradic (''in s!oradic (''
D # # i
7/25/2019 Skin Pathologies
55/130
Der$a# #esions
7/25/2019 Skin Pathologies
56/130
7/25/2019 Skin Pathologies
57/130
Li
7/25/2019 Skin Pathologies
58/130
Li!o$a
7/25/2019 Skin Pathologies
59/130
Skin #eio$yo$a
7/25/2019 Skin Pathologies
60/130
"e#oid
7/25/2019 Skin Pathologies
61/130
Skin 5asc#ar Lesions
7/25/2019 Skin Pathologies
62/130
&e$angio$as
(enign, $ore co$$on in fe$a#es 82H)9 7!!ear at birth and sa##y invo#te by
fibrosis with ti$e 8NAB of cases by N yrs of
age9
7/25/2019 Skin Pathologies
63/130
Port ?ine Stains
7/25/2019 Skin Pathologies
64/130
Port ?ine Stains
/#at often #arge he$angio$as, !resent at
birth and grow in sie as the chi#d grows.
'o$$on on the face
7/25/2019 Skin Pathologies
65/130
Strge*?eber Syndro$e
2B of !atients with P?S that invo#ve the
!!er eye#id or forehead
P?S with distribtion of the trige$ina#
nerve and inc#des vasc#ar $a#for$ation
in the ';S
7/25/2019 Skin Pathologies
66/130
7/25/2019 Skin Pathologies
67/130
"a!osi Sarco$a
;eo!#astic ce##s that #ine #y$!h or b#ood vesse#s Lesions are !r!#e, red to brown, vio#aceos
!#a0es Most co$$on#y fond on #egs and face bt co#d
a#so be $cosa# 1y!es
7:DS*re#ated '#assic 8Mediterranean9
6nde$ic 87frican9 1rans!#ant*re#ated
'ased by "a!osis sarco$a*associatedher!esvirs or &&5*@
7/25/2019 Skin Pathologies
68/130
7/25/2019 Skin Pathologies
69/130
Skin +
Jeffrey Sosnowski M.D., Ph.D.
;erofibro$atosis :
7/25/2019 Skin Pathologies
70/130
;erofibro$atosis :
;erofibro$as are the$ost co$$on t$ors
Usa##y deve#o!
arond !berty
or $ore caf*a*#ait
s!ots, !ig$ented
$ac#es
Lisch nod#es on theiris
7/25/2019 Skin Pathologies
71/130
:nfections
7/25/2019 Skin Pathologies
72/130
7/25/2019 Skin Pathologies
73/130
&er!es Si$!#e% 5irs : and ::
:, ora# her!es
:: genita# her!es
S!read throgh
kissing, sharingtoothbrshes, eating
tensi#s and se%a#
contact
7/25/2019 Skin Pathologies
74/130
7/25/2019 Skin Pathologies
75/130
:nfection>:nfestation:nfection>:nfestation
Mo##sc$ contagios$Mo##sc$ contagios$
!o%virs!o%virs
contagios, bt se#f*#i$itedcontagios, bt se#f*#i$ited
s!read by direct contacts!read by direct contact
$bi#icated !a!#es seen es!ecia##y on$bi#icated !a!#es seen es!ecia##y on
trnk and anogenita# regiontrnk and anogenita# region
7/25/2019 Skin Pathologies
76/130
7/25/2019 Skin Pathologies
77/130
7/25/2019 Skin Pathologies
78/130
1richoti##o$ania
7 disorder thatinvo#ves recrrent
rges to !## ot hair
fro$ yor sca#!
7/25/2019 Skin Pathologies
79/130
(ed (gs 8Mites9
Parasitic insects thatfeed on b#ood
7/25/2019 Skin Pathologies
80/130
Disorders of 6!ider$a#Matration
: hth i
7/25/2019 Skin Pathologies
81/130
:chthyosis
7/25/2019 Skin Pathologies
82/130
7cte :nf#a$$atory7cte :nf#a$$atory
Der$atosesDer$atoses
U i iU ti i
7/25/2019 Skin Pathologies
83/130
UrticariaUrticaria
7#so known as7#so known as
7/25/2019 Skin Pathologies
84/130
7/25/2019 Skin Pathologies
85/130
7/25/2019 Skin Pathologies
86/130
U ti i th iU ti i th i
7/25/2019 Skin Pathologies
87/130
Urticaria, !athogenesisUrticaria, !athogenesis
7ntigen*indced re#ease of vasoactive $ediators7ntigen*indced re#ease of vasoactive $ediatorsfro$ $ast ce## gran#es throgh sensitiationfro$ $ast ce## gran#es throgh sensitiation
fro$ s!ecific :g6 antibodiesfro$ s!ecific :g6 antibodies
/o##ows e%!osre to antigens sch asH !o##ens,/o##ows e%!osre to antigens sch asH !o##ens,foods, insects, drgsfoods, insects, drgs
'an a#so be :g6*inde!endent as in reactions to'an a#so be :g6*inde!endent as in reactions to
o!iates, crare, radiogra!hic contrast $edia,o!iates, crare, radiogra!hic contrast $edia,
and antibioticsand antibiotics 1hese sbstances direct#y case $ast ce##1hese sbstances direct#y case $ast ce##
degran#ationdegran#ation
7/25/2019 Skin Pathologies
88/130
/igre +2*++ Urticaria. '#inica##y, there are erythe$atos, ede$atos, often circ#ar !#a0es covered by a nor$a# e!ider$a# srface.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 5 December 2007 09:0 P!"
# 2007 $lse%ier
7/25/2019 Skin Pathologies
89/130
7/25/2019 Skin Pathologies
90/130
7 t 6 t D titi7 t 6 t D titi
7/25/2019 Skin Pathologies
91/130
7cte 6ce$atos Der$atitis7cte 6ce$atos Der$atitis
&isto#ogyH&isto#ogyH 'haracteried by s!ongiosis 8synony$ is'haracteried by s!ongiosis 8synony$ is
s!ongiotic der$atitis9s!ongiotic der$atitis9
'ases interce###ar bridges to a!!ear'ases interce###ar bridges to a!!ear!ro$inent!ro$inent
May res#t in shearing of interce###arMay res#t in shearing of interce###ar
attach$ent sites and the for$ation ofattach$ent sites and the for$ation of
intrae!ider$a# vesic#esintrae!ider$a# vesic#es
7/25/2019 Skin Pathologies
92/130
7/25/2019 Skin Pathologies
93/130
7/25/2019 Skin Pathologies
94/130
/igre +2*+2 6ce$atos der$atitis. 7, :n an acte a##ergic contact der$atitis, n$eros vesic#es a!!ear at the site of antigen e%!osre 8in this case, #andry detergent
that !ersisted in c#othing9. (, &isto#ogica##y, interce###ar ede$a !rodces widened interce###ar s!aces within the e!ider$is, eventa##y res#ting in s$a##, f#id*fi##ed
intrae!ider$a# vesic#es.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 5 December 2007 09:0 P!"
# 2007 $lse%ier
I
7/25/2019 Skin Pathologies
95/130
I
7/25/2019 Skin Pathologies
96/130
'hronic :nf#a$$atory'hronic :nf#a$$atoryDer$atosesDer$atoses
7/25/2019 Skin Pathologies
97/130
PsoriasisPsoriasis
7/25/2019 Skin Pathologies
98/130
PsoriasisPsoriasis
'o$$on'o$$on
7## ages7## ages
7rthritis, $yo!athy, entero!athy,7rthritis, $yo!athy, entero!athy,s!ondy#itic joint disease, or 7:DSs!ondy#itic joint disease, or 7:DS
Skin of e%tensor srfaces, sca#!,Skin of e%tensor srfaces, sca#!,
interg#tea# c#eft, and g#ans !enisinterg#tea# c#eft, and g#ans !enis
Psoriasis grossPsoriasis gross
7/25/2019 Skin Pathologies
99/130
Psoriasis, grossPsoriasis, gross
?e##*de$arcated,?e##*de$arcated,
7/25/2019 Skin Pathologies
100/130
7/25/2019 Skin Pathologies
101/130
7/25/2019 Skin Pathologies
102/130
Psoriasis histo#ogyPsoriasis histo#ogy
7/25/2019 Skin Pathologies
103/130
Psoriasis, histo#ogyPsoriasis, histo#ogy
7/25/2019 Skin Pathologies
104/130
7/25/2019 Skin Pathologies
105/130
L!s erythe$atossL!s erythe$atoss
7/25/2019 Skin Pathologies
106/130
L!s erythe$atossL!s erythe$atoss
7cte, sbacte, and chronic7cte, sbacte, and chronic
7cteH $a#ar erythe$aC NNB wi## have SL67cteH $a#ar erythe$aC NNB wi## have SL6
SbacteH s$a##, genera#ied,SbacteH s$a##, genera#ied,erythe$atos, so$eti$es sca#y #esionsCerythe$atos, so$eti$es sca#y #esionsC
2AB wi## have SL62AB wi## have SL6
'hronicH Loca#ied ctaneos for$ with no'hronicH Loca#ied ctaneos for$ with noassociated syste$ic $anifestations,associated syste$ic $anifestations,
discoid #!s erythe$atoss 8DL69discoid #!s erythe$atoss 8DL69
7/25/2019 Skin Pathologies
107/130
7/25/2019 Skin Pathologies
108/130
7/25/2019 Skin Pathologies
109/130
(#istering 8(##os9 Diseases(#istering 8(##os9 Diseases
7/25/2019 Skin Pathologies
110/130
Pe$!higsPe$!higs
7/25/2019 Skin Pathologies
111/130
Pe$!higsPe$!higs
4are, atoi$$ne disease, M/, age -A*4are, atoi$$ne disease, M/, age -A*2A2A
Loss of integrity of the nor$a# interce###arLoss of integrity of the nor$a# interce###ar
attach$ents within the e!ider$is andattach$ents within the e!ider$is and$cosa# e!ithe#i$$cosa# e!ithe#i$
/or variantsH/or variantsH Pe$!higs v#garisPe$!higs v#garis
Pe$!higs vegetansPe$!higs vegetans
Pe$!higs fo#iacesPe$!higs fo#iaces
Pe$!higs erythe$atossPe$!higs erythe$atoss
Pe$!higs v#garisPe$!higs v#garis
7/25/2019 Skin Pathologies
112/130
Pe$!higs v#garisPe$!higs v#garis
@AB of !e$!higs cases wor#dwide@AB of !e$!higs cases wor#dwide Mcosa and skinC often !resents with #cers inMcosa and skinC often !resents with #cers in
the $oththe $oth
S!erficia# vesic#es and b##ae that r!treS!erficia# vesic#es and b##ae that r!treeasi#yeasi#yC can invo#ve the who#e bodyC can invo#ve the who#e body
7cantho#ysis se#ective#y invo#ves the #ayer of7cantho#ysis se#ective#y invo#ves the #ayer ofce##s above the basa# ce## #ayer 8s!rabasa#ce##s above the basa# ce## #ayer 8s!rabasa#
acantho#ytic b#ister9acantho#ytic b#ister9
Unifor$#y fata# if ntreatedUnifor$#y fata# if ntreated
Pe$!higs $or!ho#ogyPe$!higs $or!ho#ogy
7/25/2019 Skin Pathologies
113/130
Pe$!higs, $or!ho#ogyPe$!higs, $or!ho#ogy
7## for$s e%hibit acantho#ysis7## for$s e%hibit acantho#ysis 6!ithe#ia# ce##s #ose attach$ents and6!ithe#ia# ce##s #ose attach$ents and
beco$e rondedbeco$e ronded
1he sing#e #ayer of basa# ce##s at the b#ister1he sing#e #ayer of basa# ce##s at the b#isterbase rese$b#es a row of to$bstonesbase rese$b#es a row of to$bstones
:n a## for$s, there is a s!erficia# der$a#:n a## for$s, there is a s!erficia# der$a#
infi#trate of #y$!hocytes, histiocytes, andinfi#trate of #y$!hocytes, histiocytes, andeosino!hi#seosino!hi#s
7/25/2019 Skin Pathologies
114/130
7/25/2019 Skin Pathologies
115/130
Pemphigus vulgaris
7/25/2019 Skin Pathologies
116/130
Pe$!higs !athogenesisPe$!higs !athogenesis
7/25/2019 Skin Pathologies
117/130
Pe$!higs, !athogenesisPe$!higs, !athogenesis
Sera contain :g3 to interce###ar ce$entSera contain :g3 to interce###ar ce$entsbstance of skin and $cossbstance of skin and $cos
$e$branes$e$branes
D:/H net*#ike !attern of interce###ar :g3D:/H net*#ike !attern of interce###ar :g3de!osits to sites of acantho#ysisde!osits to sites of acantho#ysis
5#garisH antibody to des$og#ein -5#garisH antibody to des$og#ein -
(##os !e$!higoid(##os !e$!higoid
7/25/2019 Skin Pathologies
118/130
(##os !e$!higoid(##os !e$!higoid
Distinct fro$ !e$!higsDistinct fro$ !e$!higs
'o$$on, atoi$$ne'o$$on, atoi$$ne
3enera##y affects e#der#y3enera##y affects e#der#y
Many c#inica# !resentationsMany c#inica# !resentations
Less co$$on $cosa# invo#ve$ent thanLess co$$on $cosa# invo#ve$ent than
!e$!higs 8)A*)2B9!e$!higs 8)A*)2B9
(##os !e$!higoid(##os !e$!higoid
7/25/2019 Skin Pathologies
119/130
(##os !e$!higoid(##os !e$!higoid
1ense b##ae with c#ear f#id on nor$a# or1ense b##ae with c#ear f#id on nor$a# orerythe$atos skinerythe$atos skin
Do not r!tre as easi#y as the b#isters inDo not r!tre as easi#y as the b#isters in
!e$!higs!e$!higs &ea# withot scarring, n#ess infected&ea# withot scarring, n#ess infected
:nner thigh, f#e%or srfaces of forear$s,:nner thigh, f#e%or srfaces of forear$s,
a%i##a, groin, and #ower abdo$ena%i##a, groin, and #ower abdo$en
(##os !e$!higoid !athogenesis(##os !e$!higoid, !athogenesis
7/25/2019 Skin Pathologies
120/130
(##os !e$!higoid, !athogenesis(##os !e$!higoid, !athogenesis
7ntibodies directed to !roteins at the7ntibodies directed to!roteins at theder$o*e!ider$a# jnctionder$o*e!ider$a# jnction
8he$ides$oso$e98he$ides$oso$e9
LinearLinearone de!osition of :g andone de!osition of :g andco$!#e$ent 8L!sgran#ar9co$!#e$ent 8L!sgran#ar9
(#ister deve#o!s within the #a$ina #cida(#ister deve#o!s within the #a$ina #cida
7/25/2019 Skin Pathologies
121/130
7/25/2019 Skin Pathologies
122/130
7/25/2019 Skin Pathologies
123/130
Der$atitis her!etifor$isDer$atitis her!etifor$is
7/25/2019 Skin Pathologies
124/130
Der$atitis her!etifor$isDer$atitis her!etifor$is
4areC M E /C age +A*-A4areC M E /C age +A*-A Pa!#es, vesic#es, and occasiona# b##aePa!#es, vesic#es, and occasiona# b##ae
on an erythe$atos, rticaria# baseon an erythe$atos, rticaria# base
Major association with ce#iac diseaseMajor association with ce#iac disease 4es!onds to g#ten free diet4es!onds to g#ten free diet
6%tre$e#y !rritic6%tre$e#y !rritic
(i#atera# and sy$$etrica#C e%tensor(i#atera# and sy$$etrica#C e%tensorsrfaces, !!er back, and bttockssrfaces, !!er back, and bttocks
Der$atitis her!etifor$is, histoDer$atitis her!etifor$is, histo
7/25/2019 Skin Pathologies
125/130
Der$atitis her!etifor$is, histoDer$atitis her!etifor$is, histo
Microabscesses at the ti!s of der$a#Microabscesses at the ti!s of der$a#
!a!i##ae!a!i##ae
Microsco!ic b#ister for$ation beneath theMicrosco!ic b#ister for$ation beneath thebasa# ce##s over#ying thesebasa# ce##s over#ying these
$icroabscesses 8sbe!ider$a# b#isters9$icroabscesses 8sbe!ider$a# b#isters9
6osino!hi#s cases confsion with b##os6osino!hi#s cases confsion with b##os!e$!higoid 8#ook at b#ister edge9!e$!higoid 8#ook at b#ister edge9
7/25/2019 Skin Pathologies
126/130
7/25/2019 Skin Pathologies
127/130
7/25/2019 Skin Pathologies
128/130
7/25/2019 Skin Pathologies
129/130
7/25/2019 Skin Pathologies
130/130
Top Related